How Many Calories Should I Eat to Lose Weight?

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses calorie needs, and how many calories you need to lose weight.

Many people want to know: "How many calories should I eat to lose weight?"

Any discussion of weight loss needs to start with understanding calorie intake and energy expenditure or physical activity. Weight loss is the result of eating fewer calories than your body needs or burns.

To lose weight you need to consistently reduce the number of calories in the food you eat and the beverages you drink.

For example, deceasing calorie intake by 500 calories a day for one week should result in a one pound weight loss, (500 calories/day x 7 days = 3,500 calories/week; 3,500 calories = one pound).

Write or Record It

Start recording what and how much you eat over several days. To determine your calorie intake use an online or smart phone calorie counting application, such as MyFitnessPal.com, LoseIt.com, or the Super Tracker on ChooseMyPlate.gov. Using a book on the calorie content of food or referring to the calories/serving on the nutrition facts label on food products can also provide the information needed to track calories.

Compare What You Eat vs. What You Need

Next, compare the number of calories you are eating to the number of calories your body needs to maintain your current weight. Calorie needs can be estimated using an equation that predicts an individual’s resting energy expenditure (REE). This is the amount of energy needed to maintain our basic body functions such as heartbeat, breathing, muscle tone, body temperature, and nerve function. Factors that influence REE are age, gender, height and weight.

The online applications mentioned above will calculate your energy requirements. To do it yourself - get your calculator out!

To determine your REE, you need to calculate your weight in kilograms (kg).

To determine your weight in kilograms, divide your weight in pounds by 2.2.

Then determine your height in centimeters (cm) by multiplying  your height in inches by 2.54.

The most commonly used prediction equation is the Mifflin – St. Jeor. (1)

For Men, REE = [ 10 x weight in kg] +[6.25 x height in cm] – [5 x age in years] + 5

For Women, REE = [10 x weight in kg]+ [6.25 x height in cm] – [5 x age in years ] - 161

Usually the REE is multiplied by an activity factor to estimate your total energy expenditure.

• If you are sedentary or have low activity (walking less than 2.2 miles/day) use the calculated REE for your calorie goal. 
• If you are active (walking about 7 miles a day) multiply the REE by a factor of 1.3.

To figure out your daily calorie goal for a weight loss of 1 pound per week, subtract 500 calories from your REE.

Find Other Ways To Decrease Calorie Intake

Increasing daily activities (for example taking the stairs instead of an elevator, raking leaves, pushing a stroller) or starting an exercise program (dedicating 30 to 60 minutes a day 5 days a week to moderately intense activity), will help burn more calories and help prevent weight gain. Limiting calorie intake and increasing activity is a winning combination for anyone who wants to lose weight and keep it off.

Lose Weight at Penn Medicine

Penn can help you lose weight.

Learn about medical weight loss in Philadelphia, and the Penn Bariatric and Metabolic Surgery Program at a free information session about weight-loss surgery in Philadelphia.

There, you will hear about your weight-loss surgery options, and how Penn can help you lose weight and get healthy for good.

Register for a free information session today.

1. Mifflin, MD, St Jeor, ST, Hill, LA et al. A new predictive equation for resting energy expenditure in healthy individuals. AmJ Clin Nutr 51: 241-247, 1990.

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Unhealthy “Health” Food

Rebecca Dilks, RD, LDN, research coordinator at the Center for Weight and Eating Disorders and member of the Penn Metabolic and Bariatric Surgery team, and Casey Siegel provide tips for avoiding misleading health claims and being your own healthy food judge.
 

Just because the package or ad claims that a food is “healthy” does not necessarily mean that it is. More and more, food marketers are using healthy as a marketing technique to promote foods that by most people’s definitions do not actually qualify as healthy.

Don’t fall into the food marketing health trap: Next time you are the grocery store, check the nutrition label and ask yourself the following three questions to make sure the food qualifies as healthy health food.  

1. Does it contain too much sugar?
When food manufacturers reduce the fat content in foods, they often sacrifice flavor too. To compensate, many food manufacturers add sugar.
 
Further complicating matters, the sugar listing on nutrition labels groups all sugar together, which can be deceiving. In general, try to stay away from added sugar as much as possible. The American Heart Association recommends women consume no more than 100 calories (6 teaspoons or 24 grams) of added sugar per day and men consume no more than 150 calories (9 teaspoons or 36 grams).

Fruit juices, fruit cups, granola bars and energy drinks all contain added sugar, significantly increasing the calorie content. Try fresh fruit or flavored seltzer to avoid extra sugar without skimping on flavor.

2. Does it contain too much sodium?
Food can be loaded with sodium even if it does not have that traditional salty taste. That is why you must check the sodium content on the nutrition label. Don’t assume a food’s salt content meets the healthy food requirement. Stick to foods that contain less than 140 milligrams of sodium per serving.

For example, fat-free cottage cheese, which does contain healthy nutrients like calcium, also contains 400 milligrams of sodium per four ounce serving.

3. Does it contain healthy nutrients?
Food manufacturers are onto the growing healthy diet trend and have started making snacks in healthier portion sizes than ever before. But while many of these foods have reduced calories and fat, they also fall short on healthy nutrients like fiber or protein.

Instead of reaching for a pre-packaged, manufactured snack, try opting for all natural low-calorie and low-fat snacks that also offer important nutritional benefits, like fruits and veggies.

Check out this “buyers beware” list of foods that are commonly marketed as healthy despite questionable nutritional contents:

• Bran muffins: Some may be high in fiber, but many are loaded with calories due to excessively large portion sizes.
• Trail mix and granola: These products tend to come in small portion sizes that are loaded with calories and fat. Get more bang for your buck by snacking on low-calorie, nutrient-rich foods like fresh fruits and vegetables.  
• Tuna salad: Don’t be fooled by the word “salad.” Tuna fish alone is a great choice for lean protein and omega-3 fatty acids, but by adding mayonnaise to make tuna salad you also add lots of calories and fat.  
• Dried fruit: Dried fruit contains healthy nutrients such as fiber, but it also contains large amounts of sugar. Stick with fresh fruit for all the same nutrients but with less sugar. 
• Veggie chips: These chips may have some “veggie” ingredients, but most brands do not contain whole vegetables.  

There are many food claims out there masquerading as healthy despite a lack of nutritional facts to back them up, so you be the judge. Use the nutrition label to determine which foods actually qualify as healthy by your standards, not the food marketers.

Rebecca Dilks RD, LDN
Center for Weight and Eating Disorders
University of Pennsylvania Perelman School of Medicine

Casey Siegel, University Of Pennsylvania, Class of 2012
Biological Basis of Behavior/Nutrition minor

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Lose Weight and Eat Ice Cream? The Real Scoop on the Summertime Staple

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains how to incorporate ice cream into a healthy diet. 


Whether you prefer chocolate, vanilla or a specialty flavor like mint chocolate chip, nothing screams summer like a delicious ice cream cone.

Well, get out your scooper, folks, because ice cream is no longer on the "do not eat" list for people trying to lose weight.

While ice cream can be loaded with calories, saturated fat and sugar, a variety of reduced-fat and light options are now available, which means you can enjoy this summertime treat without sabotaging your diet.

It's easy to go overboard once you start eating ice cream. To prevent overeating, use a small spoon to savor every bite and scoop your ice cream into a bowl instead of eating directly from the container. Another option is to purchase individually packaged treats like ice cream sandwiches or ice cream bars.

Always remember to check out the nutrition label before you dig into your ice cream treat. Even some ice cream varieties with the label "light" can be deceiving, which underscores the importance of reading the nutrition facts. Stick to nutrition labels that follow these guidelines:

• 120 calories or less
• 4 grams of total fat or less
• 3 grams of saturated fat or less
• 15 grams of sugar or less (equal to approximately 3 teaspoons of table sugar)

These are examples of healthy ice cream choices:

• Breyers^® Double Churned light ice cream
• Edy's^® fat free frozen yogurt or Slow Churned light ice cream
• Turkey Hill^® fat free frozen yogurt
• Whole Fruit^® no sugar added sorbet
• Skinny Cow^® low fat fudge bars or ice cream sandwiches
• Healthy Choice^® fudge bars
• Rice Dream^® frozen yogurt

- Cara Stewart, RD, LDN

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No time for a workout? 10 ways to burn 200 calories in less than an hour

“I just don’t have time!”

You’ve heard it before and in fact, have probably said it yourself, but lack of time doesn’t need to be a reason for not exercising.

If your schedule is packed from morning to night, then the drive to the gym may be a waste of your time. A workout that you can do in your own home or neighborhood may be just the ticket for you.

No matter how little time you have, you can squeeze in a quick workout or multitask by incorporating exercise into your daily household chores.

Check out these efficient ways to burn approximately 200 calories without even venturing to a gym:

If you have 10 to 15 minutes:

• Grab a jump rope. Wear quality shoes with a good cushion and jump on a flat surface.

If you have 25 to 30 minutes:

• Take the dog for a walk. Work your way up to a brisk pace of about 4 miles per hour.
• Take the stairs at the office instead of the elevator or head for the stadium steps at the local school for an intense calorie burn. 
• Ride your bike around the neighborhood or on a local trail.  A pace of 10 to 12 miles per hour is moderate intensity for most people. Ride at a faster pace or try going uphill to burn more calories at a faster pace.
• Go for a swim at the local pool. Try freestyle, breast stroke, side stroke or back stroke.

If you have 40 minutes:

• Turn on your favorite music and start dancing. Invite the family to join the dance party or enjoy it all by yourself.
• Clean the house. Keep moving and get your heart rate up while checking off a household chore.  
• Wash your car by hand. Get the hose, bucket, sponge and vacuum for a detailed clean.

If you have 50 to 55 minutes:

• Keep the yard in tip-top shape by weeding, planting flowers and spreading mulch.
• Grab your golf clubs and head to the local golf course. Opt to walk and carry your own clubs instead of taking a cart.

So the next time you’re about to give up on exercising because you don’t have enough time for a full gym workout, throw away those perfectionist tendencies and remember that doing something is always better than doing nothing.

- Cara Stewart, RD, LDN

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Healthy Mexican Cuisine: Black Bean and Cheese Enchiladas with Ranchero Sauce

This recipe for enchiladas combines various traditional Mexican flavors into one exceptionally delicious and healthy dish. Black beans provide protein, fiber, folic acid and magnesium, while the corn tortillas, chiles and cheese add crave-worthy Mexican taste.

So get cooking and thank your South of the Border neighbors for this delicious dish!

Nutritional Information:
Amount per serving

• Calories: 302
• Fat: 12.9 g
• Saturated fat: 5.3 g
• Monounsaturated fat: 3.9 g
• Polyunsaturated fat: 1.3 g
• Protein: 17.3 g
• Carbohydrate: 36.1 g
• Fiber: 6.4 g
• Cholesterol: 32 mg
• Iron: 1.7 mg
• Sodium: 574 mg
• Calcium: 426 mg

Ingredients:

• 2 dried ancho chiles, stemmed and seeded
• 2 cups water
• 2 teaspoons olive oil
• 1 cup yellow onion, chopped
• 5 garlic cloves, sliced
• 1/4 teaspoon kosher salt
• 2 cups organic vegetable broth
• 2 tablespoons fresh oregano, chopped
• 2 tablespoons no-salt-added tomato paste
• 1/2 teaspoon cumin, ground
• 1 tablespoon fresh lime juice
• 1/8 teaspoon red pepper, ground
• 1 (15-ounce) can black beans, rinsed and drained
• 2 cups (8 ounces) reduced-fat Mexican-4-cheese-blend, divided and pre-shredded
• 3 green onions, divided and thinly sliced
• Cooking spray
• 12 (6-inch) corn tortillas
• 6 tablespoons light sour cream

Preparation:

1. Preheat oven to 400 degrees.
2. Combine chiles and 2 cups water in a saucepan; bring to a boil, reduce heat and simmer for 5 minutes. Remove from heat; let stand for 5 minutes. Drain chiles in a colander over a bowl, reserving 1 cup cooking liquid.
3. Heat oil in a medium saucepan over high heat. Add onion; sauté for 1 minute. Reduce heat to medium; add garlic and salt. Cook for 5 minutes or until golden, stirring occasionally. Add broth and next 3 ingredients (through cumin); cook for 8 minutes or until thickened, stirring occasionally.
4. Pour onion mixture into a blender; add chiles and reserved liquid. Remove center piece of blender lid to allow steam to escape; secure lid on blender. Place a clean towel over opening in lid. Blend until smooth; stir in lime juice and red pepper.
5. Combine the beans, 1 cup of cheese and half of the green onions in a bowl. Spread 1/2 cup of sauce in the bottom of a 13 x 9-inch glass or ceramic baking dish coated with cooking spray. 
6. Warm tortillas according to package directions. 
7. Spoon 3 tablespoons bean mixture down center of each tortilla; roll up. 
8. Place seam-side down in prepared dish. 
9. Pour remaining sauce over filled tortillas. Top with the remaining cheese. Bake at 400 degrees for 15 minutes or until lightly browned. Sprinkle with remaining green onions; serve with sour cream.

Total preparation time, one hour and 10 minutes. Hands-on time is 55 minutes. 

This recipe is provided courtesy of David Bonom, Cooking Light (October 2011).

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Ready To Go Nuts? 6 Tips for Adding Nuts to a Healthy Diet

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains the health benefits of nuts and provides tips for incorporating them in a healthy diet. 

They say good things come in small packages and nuts are no exception. Filled with protein, fiber, phytonutrients and antioxidants, nuts pack lots of good things into a small, convenient and healthy package. They keep you satisfied, help curb unintended grazing and have powerful cancer-fighting properties.

Previously shunned by healthy dieters because of their high fat content, it turns out that nuts actually contain heart-healthy mono- and poly-unsaturated fat, which has been shown to lower LDL or “bad” cholesterol levels.

In addition to being healthy, nuts are inexpensive and have a long shelf-life, which makes them perfect for throwing in your purse or briefcase when you’re on the go.

Before going nuts with nuts, check out the following tips to incorporating them into a healthy diet:

Control portions
Nuts are high in calories, so moderation is key. Limit serving size to one to two ounces per day. 

Use nuts as a substitute
Instead of simply adding nuts to your diet, use them to replace foods that are high in saturated fats like meat, or contain empty calories.

Always read the nutrition label
Look for items with nutrition labels that say “dry-roasted” or “raw” and avoid those that just say “roasted.” Roasted nuts often contain added oils. Also, choose unsalted nut varieties.

Love the nutty flavor? Try nut butters
There are a variety of nut butter options available today including peanut, almond and cashew. Before making your purchase, make sure the nut butter does not include added ingredients like sugar or hydrogenated fat.

Store properly 
If you’re buying a large bag of nuts, store them in the freezer for maximum freshness and to aid in portion control.

Chop or grind nuts as an add-in or topping
Add nuts to yogurt, oatmeal, salad or stir-fry to infuse them with the nutty flavor while keeping portions in check. You can also mix nuts with herbs to use as a crunchy coating for fish or chicken. Sound good? Check out this healthy recipe for almond encrusted tilapia.


- Cara Stewart, RD, LDN

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Healthy Barbecue Recipe: Grilled Lemon-Basil Tofu Burgers

Nothing says summer like a barbecue. And the best part? You don’t have to break your diet to enjoy a good meal.

The next time you decide to barbecue, choose a healthy alternative to high-calorie and high-fat beef burgers or hot dogs. These crispy, marinated tofu slices topped with olive and garlic mayonnaise are delicious, quick and healthy– and it keeps you on track for achieving your weight-loss goals.

Nutritional Information:
Amount per serving

• Calories: 276
• Calories from fat: 37 percent
• Fat: 11.3 g
• Saturated fat: 1.9 g
• Monounsaturated fat: 5.7 g
• Polyunsaturated fat: 2.2 g
• Protein: 10.5 g
• Carbohydrate: 34.5 g Fiber: 1.5 g
• Cholesterol: 5 mg
• Iron: 2.4 mg
• Sodium: 743 mg
• Calcium: 101 mg

Ingredients:

• 1/3 cup finely chopped fresh basil
• 2 tablespoons Dijon mustard
• 2 tablespoons honey
• 2 teaspoons grated lemon rind
• 1/4 cup fresh lemon juice
• 1 tablespoon extra virgin olive oil
• 1/2 teaspoon salt
• 1/4 teaspoon freshly ground black pepper
• 4 garlic cloves, minced and divided
• 1 pound firm or extra firm tofu, drained
• Cooking spray
• 1/3 cup finely chopped, pitted kalamata olives
• 3 tablespoons reduced-fat sour cream
• 3 tablespoons light mayonnaise
• 6 (1 ½ ounce) hamburger buns
• 6 (1/4 inch-thick) slices tomato
• 1 cup trimmed watercress

Preparation:

1. Combine first 8 ingredients and 3 garlic cloves in a small bowl.
2. Cut tofu crosswise into 6 slices. Pat each square dry with paper towels.
3. Place tofu slices on a jelly-roll pan. Brush both sides with lemon juice mixture; reserve remaining juice mixture. Let tofu stand for an hour. 
4. Prepare grill. 
5. Place tofu slices on grill rack coated with cooking spray; grill for 3 minutes on each side then brush with the reserved juice mixture. 
6. Combine remaining minced garlic clove, chopped olives, sour cream and mayonnaise in a small bowl; stir well. Spread about 1 1/2 tablespoons mayonnaise mixture over bottom half of each hamburger bun; top each with a tofu slice, a tomato slice, about 2 tablespoons watercress and top half of bun.

This recipe is courtesy of Lorrie Hulston Corvin, Cooking Light (August 2006).

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A Guide for Making Healthy Fast-Food Choices

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, provides a guide for how to make a fast-food meal as healthy as possible.

There’s no denying that preparing food in your own kitchen is the easiest way to lose weight. When you cook at home, you control exactly what goes into your meals and you can stick to pre-planned portion sizes.

But the reality is that eating at home isn’t always possible. Whether you’re tight on time, out of groceries or just not in the mood to cook, it is possible to maintain a healthy diet while occasionally eating fast food.

This guide helps you make the healthiest possible fast-food choices.

Choose:

• Salads
• Grilled chicken sandwiches
• Open-faced sandwiches
• Chili, bean and broth soups
• Water or other unsweetened beverages 

Avoid:

• Fries
• Chips
• Cream soups
• Sugar-sweetened soft drinks
• Fried, crispy or crunchy sandwiches
• Upsized meals
• Double meat
• Bacon

You should also feel comfortable making special requests. You can modify many fast-food meals to reduce the calories or fat as well as increase the healthy nutrients.

Here are some examples of healthy special requests.

Ask for:

• Light salad dressing
• Hold the mayo or other special sauces
• Whole wheat bun
• Hold the cheese
• Grilled not fried
• Extra vegetables on sandwich
• Fruit on the side

While it is possible to incorporate fast food into a healthy diet, it is important to remember that fast-food meals must be an occasional occurrence and not a staple of your diet.

Also, keep your eyes peeled for new, healthy options on fast-food menus. More people are becoming interested in weight loss and healthy eating, and restaurants are paying attention. Healthy items like yogurt, veggie burgers and fruit are appearing on menus around the country, giving you more options for healthy food choices than ever before.

- Cara Stewart, RD, LDN

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Sleep Less, Eat More

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses a recent study that suggests a link between sleep deprivation and calorie consumption.

Approximately 20 percent of Americans get six or less hours of sleep a night, according to the National Sleep Foundation. That figure raises concern given new research that sheds more light on the major toll sleep deprivation can take on your health.

A recent study showed that people who slept less ate more, suggesting a link between sleep deprivation and obesity. The study, conducted by researchers at the Mayo Clinic, followed sleep and eating patterns of 17 healthy young men and women for 11 days.

For the first three days, researchers measured calorie consumption and energy expenditure to establish a baseline. For the remaining eight days, half of the participants slept normally while the others got just two-thirds of their normal sleep. Eating habits remained unchanged in both groups. The findings revealed that those in the sleep-deprived group consumed an average of 549 more calories a day.

Although the study was small, it supports earlier research that linked chronic sleep deprivation with a variety of adverse health effects and illnesses, including cardiovascular disease, diabetes and obesity.  Larger scale studies are needed to confirm these findings and better understand exactly why sleep deprivation leads to increased calorie consumption.

In the meantime, it seems safe to conclude that sleep is an important part of your healthy lifestyle. Just by getting in bed on time, you can cut calories without even trying. Now that’s a diet that is hard to beat!

To learn how to improve your sleep habits, click here.

- Cara Stewart, RD, LDN

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Crispy, Crave-worthy and Low-Calorie: Kale Chips Recipe

You know those days when carrots or low-fat yogurt just won’t cut it and you need a snack with a satisfying crunch? Fear not, there’s no need to resort to potato chips. Instead, try this recipe for kale chips. They’re low-calorie, filled with powerful antioxidants, a good source of calcium, fiber and vitamins A and C and they’re oven-baked, not fried. Sound too good to be true? Give them a try and you’ll be raving, too.

Ingredients:

• One bunch of kale, any type, rinsed and dried
• 2 to 3 tsp olive oil
• Salt or soy sauce, to taste
• Seasonings of choice - try chili flakes, paprika, garlic powder or Parmesan cheese*

Directions:

1. Preheat oven to 375 degrees.
2. Remove the kale leaves from the tough end and inner stems. Cut longer leaves in half or bite-size pieces. 
3. Place kale pieces in large bowl and toss in about 1 teaspoon of olive oil. The kale leaves only need to be lightly coated with oil. Too much oil makes the chips limp and greasy. If more oil is needed, add about 1 teaspoon at a time. Sprinkle in salt or soy sauce and seasonings of choice.
4. Put the kale pieces in a single layer in a baking sheet lined with parchment paper for easier cleaning. 
5. Bake for 12-15 minutes or until crisp.  Toss halfway through for more even baking. Watch carefully as they can burn easily.

Nutrition Information: Amount per serving

• Calories: 47
• Total Fat: 1.5 g
• Total Carbohydrate: 6 g
• Protein: 2 g
• Fiber: 2 g

This recipe yields 10 servings (5 large chips).

*Adding Parmesan cheese increases calorie and fat content.

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Put Down that Remote: Increase Physical Activity without Turning off the TV

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses a recent study that shows the health benefits of physical activity during television viewing. 

Have you been trying to figure out how to incorporate more exercise into your lifestyle?  A recent study published in the American College of Sports Medicine’s Medicine & Science in Sports and Exercise journal shows that you don’t even have to turn off the television to fit in a daily workout.

Researchers found that stepping in place and walking on a treadmill during television commercials significantly increase physical activity and can actually constitute a workout. They studied a group of 23 men and women, ages 18 to 65 and representing a variety of weights, and measured their calorie expenditure at rest and at different levels of activity while watching television.

Their findings show that stepping in place during the commercials of one hour of television burns an average of 146 calories per hour and results in average of 2,111 steps. Walking on a treadmill at three miles per hour for the same time period burns an average of 304 calories per hour. Both represent significant increases in physical activity when compared to remaining sedentary, which produces minimal, if any, calorie expenditure. 

So, the next time you sit down to watch your favorite television program, try moving your feet during the commercial breaks! It is an easy opportunity to burn calories and become a healthier you without missing a single minute or episode of the television shows you love.

- Cara Stewart

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Struggling to Lose Weight? SuperTracker to the Rescue!

Karen Buzby RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, introduces a new online weight management tool to help people achieve and maintain their weight loss goals.
You have probably heard before that weight loss is a matter of eating less and exercising more. Easier said than done – right? Anyone who has attempted to diet knows that translating healthy lifestyle advice to practical changes isn’t always so simple or straightforward.

SuperTracker is a new online tool that can help you plan, calculate and record caloric intake and physical activity, making weight loss easier than ever before. As part of the U.S. Department of Agriculture’s MyPlate program, SuperTracker is user friendly, interactive and contains a wealth of information to help you make smart choices about food and exercise. And it’s free.

Key features of SuperTracker include:

Daily calorie limit - Calculated based on height, weight and personal weight loss goals.

Food tracker - Record food items and portion size from an extensive database in an electronic food diary to review eating patterns and calorie balances each day.

Food group targets and graphs – Provides recommendations about number of servings from each food group based on a person’s daily caloric allowance. It also graphs food choices to show how dietary choices measure up to goals.

Personalized nutrient report – Customized reports of individuals’ average carbohydrate, protein, fat, vitamin and mineral intake. Helps identify which foods to eat more of and which to cut back on.

Physical activity tracker – Compares weekly physical activity totals to pre-set targets for moderate-intense and muscle-strengthening exercise.

Virtual healthy lifestyle coach – Advice, inspiration and support from a virtual coach helps people stay motivated and reach their weight loss goals.

Don’t wait another day. Start tracking your diet and activity goals with the SuperTracker today! 

- Karen Buzby, RD, LDN

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Shape Up Your Plate in Honor of National Nutrition Month

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, discusses a new government-sponsored program to encourage better food choices and provide tips for eating healthy.
March is National Nutrition Month and the Academy of Nutrition and Dietetics is providing you the information you need to achieve a healthier lifestyle. But even after you make the commitment to eating healthy, figuring out how to achieve that on a meal-to-meal basis can be tough and confusing. The U.S. Department of Agriculture has developed a program to help.

MyPlate is an online resource that provides dietary advice based on the 2010 Dietary Guidelines for Americans. Unlike other diet guides, MyPlate uses an actual place setting to visually illustrate a healthy meal made up of all the major food groups. That means no more confusion about how to translate dietary advice to an actual meal and no more guessing about portion size.

Follow these tips to get your plate in shape*:

Balance calories
If you’re unsure how many calories you need to manage your weight, there’s no need to guess! Go to www.ChooseMyPlate.gov to find out your daily caloric needs. MyPlate provides the recommended number of daily servings from each food group to help you make smart and healthy dietary choices.

Enjoy your food, but eat less
Take your time to eat and pay attention to feelings of fullness.

Avoid oversized portions
Use smaller plates to encourage smaller portions. When eating out, opt to share a meal or take home part of the serving.

Fill up on nutrient-rich foods
Make vegetables, fruit, whole grains and low-fat dairy products staples in your diet. They’re high in nutrients and vitamins and low in fat, making them ideal food choices for good health. In fact, experts recommend covering half your plate with fruits and vegetables and ensuring that half your grains are whole grains.

Always choose low- or non-fat milk
By choosing fat-free or 1 percent low-fat milk, you cut calories and fat without losing the flavor or important nutrients like calcium and vitamin D.

Curtail your sweet tooth
There’s no doubt that sweet foods and beverages are both tasty and addicting, but they’re also high in fat, sugar and salt. Eat them only occasionally and in small quantities to satisfy your sweet tooth without compromising your healthy diet. One easy way to do this is by replacing sugar beverages with water and unsweetened drinks. 

Pay attention to sodium
You might be surprised by the sodium content in everyday foods. Before making a food selection, read the nutrition facts label and stick to foods that are low in sodium to help promote cardiovascular health.

For more information, visit the MyPlate website. 

- Karen Buzby, RD, LDN

*USDA, Center for Nutrition Policy and Promotion, DG Tip Sheet No. 1, June 2011.

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Drinking Alcohol after Weight Loss Surgery

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains how to incorporate alcohol in a healthy diet after weight loss surgery.

People considering weight loss surgery often ask if it is possible to safely incorporate alcohol into a healthy diet and lifestyle after surgery. The short answer is “yes,” but gradually and with modifications. Here’s why:
       
Altered metabolism
Research shows that blood alcohol levels peak higher and faster and take longer to return to normal due to altered metabolism after gastric bypass surgery. In addition, many post-surgical patients consume less food when they’re drinking alcohol, which contributes to expedited absorption of alcohol in the blood stream. For many post-surgical patients, all it takes is a single drink to elevate blood alcohol level to the point of legal intoxication. This is important to remember for maintaining a healthy diet and before getting behind the wheel.

Low blood sugar
Rapid weight loss and low carbohydrate intake can lead to reduced sugar or glycogen in your body. Alcohol consumption further depletes glycogen, which causes your blood sugar levels to drop, putting those who have had bariatric surgery at higher risk for developing low blood sugar.

Hypoglycemia, or low blood sugar, is a dangerous condition that can lead to loss of consciousness, brain and nerve damage or even death if left untreated. As a result, it’s important to be on the lookout for symptoms, which include loss of coordination and balance, slurred speech, poor vision and confusion.

If you experience symptoms of hypoglycemia, drink diluted juice or take a glucose tablet immediately to raise your blood sugar level, and then have a snack with complex carbohydrates and protein to sustain it. If hypoglycemic episodes occur frequently even without alcohol consumption, make sure you seek proper medical treatment.

Excess calories
Alcohol is high in calories and low in nutrients, which is why excess calories from alcohol can slow weight loss or even contribute to weight gain. 

Addiction transfer
Patients with a history of addiction are at higher risk for developing a new addiction. With the dramatic reduction of food consumption after bariatric surgery, some patients may trade their food addiction for other addictive behaviors, including drugs, shopping, gambling, sex and alcohol.

Guidelines for drinking:
Follow these guidelines to re-introduce alcohol without compromising your commitment to a healthy lifestyle after weight loss surgery:

• Avoid alcohol for the first six months after bariatric surgery.
• When you get permission to start drinking alcohol again, avoid carbonated beverages and sugary drink mixers. 
• Remember that after surgery, even small amounts of alcohol can cause intoxication and low blood sugar. 
• Never drink and drive, even after consuming only minimal alcohol. 
• Only drink with meals or while eating to help slow absorption of alcohol. 
• Be aware of the calorie content of alcohol.
• If you find yourself drinking regularly to cope with emotions or stress, seek help by consulting with your doctor.

- Cara Stewart

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Healthy Bites for People on the Go: Meal and Snack Bars

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, explains the nutritional value of meal and snack bars and provides a guide for making healthy selections. 

It can be hard to fit healthy eating into a busy lifestyle. Between work, family, social obligations and more, sometimes it feels like there’s not enough time to prepare or sit down for a healthy, balanced or home-cooked meal.

But a shortage of time does not mean you have to sacrifice your commitment to healthy eating!

In fact, snack and meal replacement bars are perfect items to stock up on for those moments when you’re strapped for time and need a healthy bite to eat. They are easy, convenient, portable and if you make smart choices, they can be healthy, too.

From breakfast bars to granola bars to energy bars and protein bars, it’s hard to know which variety is the best, most healthful choice. The wide variety of bars on the market can make selection overwhelming and it doesn’t help that many bars masquerade as healthy despite being packed with sugar and fat.

Use this guide to find a healthy snack or meal replacement bar for the next time your stomach is grumbling but you’re on the way out the door.

Meal Replacement Bars
These bars are ideal when you’re in a rush and otherwise would skip a meal. Look for the following nutritional requirements per serving when making a selection:

• 200 to 300 calories
• At least 15 grams of protein
• At least 5 grams of fiber
• Less than 20 grams of sugar (Less than 10 grams of sugar for people who had gastric bypass surgery)
• Less than 10 grams of total fat
• Less than 2.5 grams of saturated fat

Snack Bars
Snack bars are great for quenching hunger between meals or as fuel before a workout. Make sure that your snack bar contains the following nutritional requirements per serving:

• 150 to 200 calories
• At least 5 grams of protein
• At least 3 grams of fiber
• Less than 15 grams of sugar
• Less than 7 grams of total fat
• Less than 2 grams of saturated fat

These general considerations are helpful to keep in mind when deciding which meal or snack bars to purchase:

• Bars that are low in carbohydrates are generally low in fiber or high in fat, especially saturated fat. Be careful that you’re not trading one unhealthy nutrient for another.
• Some bars, especially those that are low in sugar and carbohydrates, contain sugar alcohols, which can cause bloating, gas and diarrhea.  
• Bars that contain fruit naturally have more sugar. With fruit bars, you can be more flexible with the sugar content per serving.
• Pay attention to flavor and consistency. Make sure that you actually enjoy the taste of the bar!

Snack and meal bars made specifically for people who have had bariatric surgery are available on the following websites:

• BariatricAdvantage.com
• BariatricChoice.com
• BariatricEating.com
• DoctorsBestWeightLoss.com

- Cara Stewart, RD, LDN

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Buon Appetito: Eggplant Parmesan – the healthy way

An Italian favorite, Eggplant Parmesan is typically made with fried eggplant and loads of high-fat cheese – a dieter’s nightmare! But there are ways to modify the recipe so it fits into your healthy diet. To reduce the calories, fat and sodium while retaining the flavor, try this healthy recipe for Eggplant Parmesan.

Ingredients:
Eggplant

• 2 large eggs, lightly beaten
• 1 tablespoon water
• 2 cups whole-wheat panko (Japanese breadcrumbs)
• 1/4 cup (1 ounce) grated fresh Parmigiano-Reggiano cheese
• 2 (1 pound) eggplants, peeled and cut crosswise into ½-inch slices
• Cooking spray

Filling

• 1/2 cup torn fresh basil
• 1/4 cup (1 ounce) grated fresh Parmigiano-Reggiano cheese
• 1/2 teaspoon crushed red pepper
• 1 1/2 teaspoons minced garlic
• 1/4 teaspoon salt
• 1 (16 ounce) container part-skim ricotta cheese
• 1 large egg, lightly beaten
• 1 (24 ounce) jar premium pasta sauce
• 1/4 teaspoon salt
• 8 ounces thinly sliced mozzarella cheese
• 3/4 cup (3 ounces) finely grated fontina cheese

Preparation:

1. Preheat oven to 375 degrees.
2. Eggplant: Combine 2 eggs and 1 tablespoon of water in a shallow dish. Combine panko and 1/4 cup Parmigiano-Reggiano in a second shallow dish. Dip eggplant in egg mixture; dredge in panko mixture, pressing gently to adhere and shaking off excess. Place eggplant slices 1 inch apart on baking sheets coated with cooking spray. Bake at 375 degrees for 30 minutes or until golden, turning once and rotating baking sheets after 15 minutes.
3. Filling: Combine basil, Parmigiano-Reggiano cheese, red pepper, garlic, salt, ricotta cheese and egg.
4. To assemble, spoon 1/2 cup pasta sauce in bottom of a 13 x 9 inch glass baking dish coated with cooking spray. Layer half of eggplant slices over pasta sauce. Sprinkle eggplant with 1/8 teaspoon salt. Top with about 3/4 cup pasta sauce. Spread half of ricotta mixture over sauce and top with a third of mozzarella and 1/4 cup fontina cheese. Repeat layers once, ending with about 1 cup pasta sauce. Cover tightly with aluminum foil coated with cooking spray. Bake at 375 degrees for 35 minutes. Remove foil; top with remaining third of mozzarella and 1/4 cup fontina cheese. Bake at 375 degrees for 10 minutes or until sauce is bubbly and cheese melts; cool 10 minutes.

Nutritional Information:
Amount per serving

• Calories: 318
• Fat: 15.1 g
• Saturated fat: 8.2 g
• Monounsaturated fat: 2.7 g
• Polyunsaturated fat: 0.6 g
• Protein: 19.3 g
• Carbohydrate: 26.8 g
• Fiber: 4.8 g
• Cholesterol: 99 mg
• Iron: 1.6 mg
• Sodium: 655 mg
• Calcium: 365 mg

The recipe yields 10 servings. Serving size is one slice. Preparation time is one hour and 45 minutes.

This recipe is courtesy of Kathy Kitchens Downie, RD, Cooking Light (September 2010).

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Tasty Ways to Keep Your New Year’s Resolution: Sweet and Sour Shrimp

A New Year’s resolution to lose weight does not have to mean sacrificing your favorite cuisines, such as Chinese food. Many Chinese menu items are loaded with fat, calories and sodium, but there are ways to prepare healthier versions that preserve the flavorful taste you love. This sweet and sour shrimp is nutritious, low in fat and calories and takes less than 30 minutes to prepare.

Ingredients:

• 1 (3 1/2-ounce) bag boil-in-bag brown rice
• 8 ounces firm, light tofu
• 2 tablespoons cornstarch, divided
• 1/2 pound peeled, large shrimp (approximately 15 to 17 medium-sized shrimp)
• 1/4 cup fat-free, low-sodium chicken or vegetable broth
• 1/4 cup low-sodium soy sauce
• 2 tablespoons sugar
• 3 tablespoons rice vinegar
• 1 tablespoon chili paste with garlic
• 2 teaspoons dark sesame oil
• 2 teaspoons canola oil
• 1 cup chopped onion
• 1/2 cup chopped green bell pepper
• 1 tablespoon ground fresh ginger
• 1 (8-ounce) can pineapple chunks in juice, drained

Preparation:

1. Cook rice according to package directions, omitting salt and fat; set aside.
2. Place tofu between paper towels until barely moist; cut into 1/2-inch cubes. Combine tofu, one tablespoon cornstarch and shrimp. Combine remaining cornstarch, broth, soy sauce, sugar, vinegar and chili paste; set aside. 
3. Heat sesame oil in a large nonstick skillet over medium-high heat. Add shrimp mixture to pan; sauté for three minutes. Place shrimp mixture in a bowl. Heat canola oil in pan over medium-high heat. Add onion, bell pepper, ginger and pineapple to pan; sauté for two minutes. Add shrimp mixture; cook for one minute. Add broth mixture to pan; cook for one minute. Serve over rice.

Nutritional Information:
Amount per serving

• Calories: 318
• Calories from fat: 19 percent
• Fat: 6.8 g
• Saturated fat: 1 g
• Monounsaturated fat: 2.7 g
• Polyunsaturated fat: 1.3 g
• Protein: 19.8 g
• Carbohydrate: 45.4 g
• Fiber: 4 g
• Cholesterol: 86 mg
• Iron: 2.7 mg
• Sodium: 681 mg
• Calcium: 89 mg

The recipe yields four servings. Serving size is one cup of shrimp and half a cup of rice.

This recipe is courtesy of Cooking Light (May 2008).

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Having a Baby After Weight Loss Surgery

Cara Stewart, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, and Monica A. Mainigi, MD, fertility specialist at Penn Fertility Care, provide important information for women trying to become pregnant and maintain a healthy pregnancy after weight loss surgery.

Many women struggle with fertility as a result of their weight. In fact, obesity puts women at greater risk for ovulation dysfunction and menstrual irregularity, both of which can interfere with fertility. In addition, obesity can lead to an increased risk of miscarriage and decreased success with fertility treatments. For overweight women who are having a hard time conceiving, weight loss surgery may be an option to consider.

For women considering pregnancy after they have had bariatric surgery, it is important to keep the following information in mind.


Fertility boost
Obesity can interfere with hormone production, making it more difficult to get pregnant.  Weight loss after bariatric surgery can lead to regular cycles and ovulation, and improved fertility. In fact, a 2005 study published in the Journal of Clinical Endocrinology and Metabolism found that surgical weight loss for women with PCOS often resolved their reproductive and metabolic abnormalities. 

Healthier pregnancy, healthier baby
After weight loss surgery, medical conditions such as high blood pressure and diabetes are significantly improved or resolved leading to a lowered risk of developing serious complications during pregnancy or delivering a baby born with complications.  Many women are still obese after weight loss surgery which places them at a higher risk for gestational diabetes and preeclampsia, but the risk is far less than before surgery.  Pregnant women who have had bariatric surgery should see a high-risk obstetrician to best manage prenatal care.

Give it time
It is important to wait at least 18 months after surgery to start trying to get pregnant. In the period immediately following gastric bypass or sleeve gastrectomy, rapid weight loss causes stress on the body, including diminished nutrition intake, which can cause complications for an expecting mother and growing baby. Effective contraception is absolutely critical for women pursuing weight loss surgery.  For women with an adjustable gastric band, fluid may be removed from the band during pregnancy to accommodate the need to eat more calories.

Keep supplementing
Good nutrition is especially important for women trying to conceive.  After weight loss surgery, patients are at a higher risk for deficiencies of certain nutrients, including vitamin B12, folic acid, calcium, iron, and vitamin D. It essential to continue taking vitamin and mineral supplements as recommended by the bariatric team.

Be ready for weight gain
After having weight loss surgery, it can be difficult to accept that pregnancy is a time when it is normal, healthy and necessary to gain weight.  Healthy weight gain during pregnancy is important to nourish a growing baby, but work with the program dietitians to avoid unhealthy weight gain during pregnancy.

The Penn Metabolic and Bariatric Surgery Program offers lifelong follow-up care and nutritional support for patients who have had weight loss surgery. Women considering pregnancy after weight loss surgery should discuss their plans with the bariatric surgery team.

For more information on fertility services at Penn Medicine, visit the Penn Fertility Care website.

- Cara Stewart, RD, LDN and Monica Mainigi, MD

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Tips for Healthy Holiday Eating After Weight Loss Surgery

Karen Buzby, RD, LDN, member of the Penn Metabolic and Bariatric Surgery team, provides tips for managing your post-surgical diet during the holidays.

There is no getting around it. Food is a central part of the holiday season. Whether you’re enjoying holiday food with friends and family or inundated with unhealthy treats at the office, it is hard to maintain your healthy eating goals over the holiday season, but it is possible.

These tips can help you stay on track with your post-surgical diet and lifestyle changes while still allowing you to enjoy the holiday festivities.

Don’t skip meals
Always make time for breakfast, lunch and dinner. Going long stretches without eating can lead to eating too much or too quickly and cause nausea or vomiting in people who have had weight loss surgery. It can also result in unhealthy food choices due to overwhelming hunger.

Be selective about food choice
Resist the temptation to try foods that are high in sugar and fat. After gastric bypass surgery, fatty and sugary foods can cause “dumping syndrome,” resulting in severe abdominal pain and cramping, diarrhea, nausea and vomiting. Instead, choose low-calorie party foods such as raw vegetables, fruit with yogurt dip or boiled shrimp with lemon or cocktail sauce.

Stay well hydrated
Stay hydrated by drinking water and low-calorie beverages. Avoid alcoholic beverages and try to separate eating and drinking by 30 minutes.

Keep a food diary
Research* shows that recording what you eat helps you stay on track during the holidays. It also helps you meet your protein and fluid goals. Take a minute each night to record your food and fluid intake for the day.

Click here for more healthy eating tips for you and your family.

- Karen Buzby, RD, LDN


*Cornett R, Akers J, Salva J, Zoellner J, Davy B. Daily self-monitoring during the winter holiday period: a feasible strategy for holiday weight maintenance. SCAN’s PULSE. Fall 2011, Vol 5, No 4: 1 – 6.

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Eat Right When Eating Out

Karen Buzby, RD, LDN, and Cara Stewart, RD, LDN, members of the Penn Metabolic and Bariatric Surgery team, offer these tips for eating healthy when dining out.

Dining out can be a challenge for anyone trying to follow a healthy eating plan, but it is especially difficult if you have had weight loss surgery. Restaurant portions are notoriously large and the meals are often packed with sodium and hidden calories from fats, sugars and sauces. Before weight loss surgery, larger portions may have tempted you to eat more than you wanted or needed. After weight loss surgery, the food may go to waste or cause discomfort. 

The following tips can help you enjoy your meal out while sticking to your diet plan.

Limit calories:

• Be conservative with food selection, especially during the first few months after surgery. Stick with simple prepared foods.
• Before ordering, ask yourself: “Is this food pouch worthy?” Make sure you order foods that are a good source of protein and fiber.
• Look for heart-healthy, low-fat or light options. U.S. Food and Drug Administration (FDA) regulations require restaurants to back up their health claims. Feel free to ask for nutrition information if it is not already provided.
• Stay away from the bread and chip baskets as well as dessert and alcohol menus. Ask the server not bring out the dessert cart. If you choose to eat bread, opt for a small, plain yeast roll and avoid items with added fat like garlic bread, cornbread, croissants and muffins.  
• Salad dressings are often high in calories and fat. Always order dressing on the side and ask for low-fat dressing, a lemon wedge or flavored vinegar instead of the full fat and calorie version. 
• Don’t drink your calories. Quench your thirst with calorie-free drinks like water or unsweetened iced tea. Limit or avoid alcoholic beverages.
• If your job requires socializing or doing business over meals, call ahead or go online to learn about your options in advance. Inform the restaurant manager of your dietary restrictions and make special requests ahead of time if necessary.
• Savor each bite of food, enjoy the company and take your time. Allow at least 20 to 30 minutes for each meal. Remember, conversation is calorie-free!

Control portion sizes:

• Watch your portion size. People who have had bariatric surgery receive a “restaurant card” to request smaller portions when dining out. Use it to make sure your meals are an appropriate size.
• Share a meal or order a smaller portion. This reduces portion size and the expense as well.  
• Order from the lunch menu if it is available. Often the lunch menu offers smaller and less expensive entrees.
• Order from the children’s menu if there are healthy selections available.
• Order an appetizer as a main entrée. The portions of appetizers are usually two to four ounces, which is the ideal meal size after weight loss surgery. 
• Ask the waiter to split the main dish and box half before serving it. You can also request a “doggie bag” as soon as you feel satisfied to avoid the temptation of overeating. 
• Try a tapas restaurant, which serves snack-sized appetizers and entrées.  

Manage leftovers:

• When you take home leftovers, remember to refrigerate the food promptly to avoid food-borne illness. Food left out for more than two hours may not be safe to eat.
• Write the date of purchase or preparation on leftovers and remember to discard the food after three to five days. Always follow the mantra: “When in doubt, throw it out.” Plus, you don’t want your refrigerator to turn into a jungle of leftover containers. 
• Reheat food thoroughly.

- Karen Buzby, RD, LDN and Cara Stewart, RD, LDN

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